Basic Information
| Provider Information | |||||||||
| NPI: | 1205280054 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROUTHIER | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | BRYCE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2395 JOLLY RD STE 160 | ||||||||
| Address2: | |||||||||
| City: | OKEMOS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488645977 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5173015011 | ||||||||
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| Practice Location | |||||||||
| Address1: | 37450 SCHOOLCRAFT RD | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | LIVONIA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481501082 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7344584601 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2016 | ||||||||
| LastUpdateDate: | 04/30/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | N | Other Service Providers | Case Manager/Care Coordinator | 101YM0800X | 6401016475 | MI | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.